IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311383
Open Access Review
A Review of Cardiovascular Complications among Pregnant Patients with COVID-19
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1 Department of Cardiology, Kaiser Permanente, Santa Clara, CA 95051, USA
2 Department of Cardiology, Kaiser Permanente, San Francisco, CA 94115, USA
3 Department of Maternal Fetal Medicine, Kaiser Permanente, Santa Clara, CA 95051, USA
*Correspondence: alix.j1.pruzansky@kp.org (Alix J. Pruzansky)
These authors contributed equally.
Academic Editor: Sophie Mavrogeni
Rev. Cardiovasc. Med. 2022, 23(11), 383; https://doi.org/10.31083/j.rcm2311383
Submitted: 2 June 2022 | Revised: 15 August 2022 | Accepted: 25 August 2022 | Published: 16 November 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Cardiovascular complications of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection are well-described in the general population but remain limited among pregnant patients. This review summarizes data from case reports, case series, and observational studies of cardiovascular manifestations of corona virus disease 2019 (COVID-19) in pregnant patients and provides recommendations to the cardiovascular clinician regarding management considerations in this vulnerable population. Pregna is an immunocompromised state in which cardiovascular demands are increased. Cardiovascular complications of COVID-19 that have been described in pregnancy include myocardial injury, cardiomyopathy, thromboembolism, pre-eclampsia and arrhythmia. Physiologic and cardiovascular changes in pregnancy predispose pregnant patients with COVID-19 to more severe illness than the general population. Black or Hispanic race, obesity, diabetes, hypertension and lung disease are risk factors for more severe infection, maternal death and adverse perinatal outcomes. Pregnant patients with severe COVID-19 disease compared with non-pregnant age-matched women with COVID infection are more likely to be admitted to the intensive care unit (ICU), receive mechanical ventilation and require advanced mechanical circulatory support. Cardiovascular complications of COVID-19 in pregnant patients requires further attention, particularly given the anticipated increase in birth volume and ongoing nature of COVID-19 pandemic with novel variants. Clinicians should have a lower threshold for cardiac testing and multidisciplinary management in pregnant women with severe COVID-19 disease. Given the persistence of COVID-19 within our communities, diagnostic laboratory and imaging testing for high-risk pregnant patients hospitalized with COVID-19 infection should be routine. We strongly urge the implementation of a cardio-obstetric multidisciplinary team in individually managing these high-risk patients in an effort to improve maternal and fetal outcomes.

Keywords
COVID-19
pregnancy
cardiovascular complications
Highlights

• Known cardiovascular complications of COVID-19 associated with pregnancy include myocardial injury, cardiomyopathy, thromboembolism, pre-eclampsia, and arrhythmia.
• Physiologic and cardiovascular changes in pregnancy predispose parturients with COVID-19 to more severe illness than the general population.
• Among pregnant patients with COVID-19, race/ethnicity (Black or Hispanic), obesity, diabetes, hypertension and lung disease are risk factors for severe infection and adverse perinatal outcomes, including increased cesarean delivery, hypertensive disorders of pregnancy, and maternal death.
• Clinicians should have a lower threshold for cardiac testing and multidisciplinary cardio-obstetric management among pregnant patients with severe COVID-19 infection.

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